Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility.
Sandra M Shi, Innokentiy Bakaev, Helen Chen and 2 others
PMID 32981664WHAT IT FOUND
In a large nursing home, 45.5% of residents who tested positive for COVID-19 had no symptoms at diagnosis.
Male sex, bowel incontinence, and staff living in high-prevalence communities were linked to infection, while 30.1% of infected residents died.
Key findings
01Nearly half of residents who tested positive were asymptomatic at the time of testing, and 15.0% remained asymptomatic throughout follow-up.
02Adjusted analysis identified male sex and bowel incontinence as significant predictors of testing positive, alongside the proportion of staff living in high-prevalence communities.
03The case fatality rate among infected residents was 30.1%, rising to 50.0% in those with moderate-to-severe frailty.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The study was conducted in a single academic facility with a population older and sicker than typical community nursing homes. Clinical data came from retrospective chart review, which likely led to underreporting of symptoms like delirium. Staff were not universally tested for COVID-19, so the link between staff residence and resident infection is indirect. Staff movement between units occurred later in the study, potentially confounding unit-level analyses.
The easy way to misread this
Do not assume that the association between staff community residence and resident infection proves direct transmission from those specific staff members, as staff were not tested. Additionally, the high mortality rate reflects a frail, academic population and may not apply to all nursing home settings.